ENDOUROLOGY & LAPAROSCOPY

Laparoscopic skills training using a webcam trainer
Chung SY, Landsittel D, Chon CH, Ng CS, Fuchs GJ
Endourology Institute, Cedars-Sinai Medical Center, Los Angeles, California USA
J Urol. 2005; 173:180-3

• Purpose: Many sophisticated and expensive trainers have been developed to assist surgeons in learning basic laparoscopic skills. We developed an inexpensive trainer and evaluated its effectiveness.
• Materials and Methods: The webcam laparoscopic training device is composed of a webcam, cardboard box, desk lamp and home computer. This homemade trainer was evaluated against 2 commercially available systems, namely the video Pelvitrainer (Karl Storz Endoscopy, Culver City, California) and the dual mirror Simuview (Simulab Corp., Seattle, Washington). The Pelvitrainer consists of a fiberglass box, single lens optic laparoscope, fiberoptic light source, endoscopic camera and video monitor, while the Simuview trainer uses 2 offset, facing mirrors and an uncovered plastic box. A total of 42 participants without prior laparoscopic training were enrolled in the study and asked to execute 2 tasks, that is peg transfer and pattern cutting. Participants were randomly assigned to 6 groups with each group representing a different permutation of trainers to be used. The time required for participants to complete each task was recorded and differences in performance were calculated. Paired t tests, the Wilcoxon signed rank test and ANOVA were performed to analyze the statistical difference in performance times for all conditions.
• Results: Statistical analyses of the 2 tasks showed no significant difference for the video and webcam trainers. However, the mirror trainer gave significantly higher outcome values for tasks 1 and 2 compared to the video (p = 0.01 and < 0.01) and webcam (p = 0.04 and < 0.01, respectively) methods. ANOVA indicated no overall difference for tasks 1 and 2 across the orderings (p = 0.36 and 0.99, respectively). However, by attempt 3 the time required to complete the skill tests decreased significantly for all 3 trainers (each p < 0.01).
• Conclusions: Our homemade webcam system is comparable in function to the more elaborate video trainer but superior to the dual mirror trainer. For novice laparoscopists we believe that the webcam system is an inexpensive and effective laparoscopic training device. Furthermore, the webcam system also allows instant recording and review of techniques.
  
  
• Editorial Comment
  The lack of well defined training to optimize the learning curve for laparoscopic procedures is still a challenge. The old saying, see one, do one, teach one, does not seem to apply to laparoscopy, as the authors mentioned. The study evaluated dry lab training for laparoscopic skills using established tasks with different types of trainers: 1) Pelvitrainer ($2,095) 2) Simuview ($300), and 3) a homemade webcam system ($30). Forty two participants without prior laparoscopic training were asked to execute 2 basic tasks: 1) peg transfer (task 1) and 2) pattern cutting (task 2). The participants were randomly assigned to different groups. The time required for participants to complete each task was recorded and differences in performance were calculated. Although the Simuview was effective, it showed significantly worse performance time compared to the other 2 systems, since it did not provide magnification. The authors concluded that the homemade laparoscopic trainer offers easy setup and use with comparable quality to the fancier pelvic trainers allowing the user to record and play back sessions for personal review or to have a distant proctor assisting via the Internet.
  Unquestionably, better educational and training tools need to be developed to decrease the learning curve and minimize complications in laparoscopic surgery. Certainly virtual simulation models as well as training programs and centers are in need not only to grant the initial training but also to provide assistance in the clinical setting.

Dr. Fernando J. Kim
Assistant Professor of Urology
University of Colorado Health Sciences Center
Denver, Colorado, USA